Los Altos Recreation & Community Services LosAltosRecreation.org
REGISTRATION Form
REGISTRATION Form
FEE
Household Contact Information (Please Print)
Home Address City Zip
E-mail Adress Cell Phone
Home Phone
Emergency Contact
PARTICIPANT SIGNATURE (Parent or Guardian if under 18)
Emergency Contact Phone
Date
Last Name
First Name
I have special needs requiring specic accommodations to fully enjoy a class or facility.
Please contact us at info@losaltosrecreation.org or 947-2790.
PARTICIPANT NAME (First & Last)
BIRTHDATE M/F CLASS CODE CLASS TITLE FEE
TOTAL DUE:
PAYMENT OPTIONS:
• Checks made payable to City of Los Altos
• Visa, MasterCard, Discover or American Express credit cards
• Cash payments must be made in person;
please do not mail cash
REGISTRATION FORM RETURN OPTIONS:
• Email form to info@losaltosrecreation.org
• Mail form to 1 N San Antonio Rd, Los Altos, CA 94022
• Fax form to 947-2738
City of Los Altos Recreation & Community Services • 1 N San Antonio Rd, Los Altos, CA 94022
READ & SIGN BELOW: Through this registration form, I hereby absolve the City of Los Altos, its employees & ocers from all liability which may
arise as the result of my participation in the activities listed below, and in the event that the below-named participant is a minor.
I hereby give my permission for his/her participation as indicated & in so doing absolve the City of Los Altos, its employees & ocers from such
liability. In addition, I agree to allow use of my/our photograph for program publicity. I have read & understand the City of Los Altos Recreation
& Community Services Department refund policy. Furthermore, reservation of a place in a class or program does not constitute any form of
guarantee by the City of Los Altos that the class or program will take place. The City of Los Altos reserves the right to cancel any program or
class at any time for any reason, at its sole discretion. Money paid in advance for any class or program that is canceled by the City of Los Altos
will be refunded in full.
REFUNDS & TRANSFERS Refund and transfer requests must be submitted in writing up to the day prior to the second class meeting. All refunds
will be charged a $20 service fee. Email your refund and transfer request to info@losaltosrecreation.org. No refunds or transfers will be given
aer the day prior to the second class meeting.
Cardholder Name:
Card Number:
Exp. Date:
Signature:
CREDIT CARD PAYMENT (check one)
Visa MasterCard Discover American Express
